- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $8,007.30 / $16,642.00
| Facility | | $6,303.00 | $8,007.30 | $16,642.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,575.80 / $14,545.35 / $19,516.73
| Facility | | $10,575.80 | $14,545.35 | $19,516.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,665.02 / $11,899.37 / $16,680.96
| Facility | | $8,665.02 | $11,899.37 | $16,680.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,543.68 / $13,215.58 / $16,660.53
| Facility | | $7,543.68 | $13,215.58 | $16,660.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,543.68 / $13,325.60 / $17,473.83
| Facility | | $7,543.68 | $13,325.60 | $17,473.83 |